赤石脂（一斤一半全用一半筛末） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米令熟。去滓。温服七合。内赤石脂末方寸匕。日三服。若一服。愈余勿服。
成注云。湿可去脱。赤石脂之涩。以固肠胃。辛以散之。干姜之辛。以散里寒。粳米之甘。以补正气。内台方
议云。阳病下利便脓血者。为协热也。属白头翁汤。少阴病下利便脓血者。为下焦不约而里寒也。故用赤石脂为君
而固肠胃。涩可去脱也。干姜为臣。散寒温气。辛以散之也。粳米为佐使。以补正气而安其中。甘以缓之也。
或问桃花汤。非入少阴之剂。何以治少阴下利。余答云。邪中少阴。寒在肠胃。仲景用桃花汤以治寒利。亦犹
之治少阴病自利清水。色纯青。心下必痛。口干燥者。宜大承汤。其汤未尝入少阴。止以下肠胃中之实。而经中之
热自平。同一理耳。
少阴病。二三日。至四五日。腹痛。小便不利。下利不止。便脓血者。桃花汤主之。（此条少阴病。下利更加
腹痛。其中寒则甚于前矣。少阴之脉行于腹。今病起自二三日至四五日。寒邪入里已深。故腹痛也。小便不利者。
下焦为寒邪所阻。阑门受伤。水液并入大肠。遂下利不止。甚至津液滑脱而为脓血。成注云。肠胃虚弱。下焦不固
也。与桃花汤。以温胃。固肠。散寒气。○或问下利脓血。使不问病于何日起。兼之腹痛。小便不利。焉知非协热
证。余答云。少阴里寒便脓血。所下之物。其色必黯而不鲜。乃肾受寒湿之邪。水谷之津液。为其凝泣。酝酿于肠
胃之中。而为脓血。非若火性急速而色鲜明。盖水伏已久。其色黯黑。其气不臭。其人必脉微细。神气静而腹不甚
痛。喜就温暖。欲得手按之。腹痛即止。斯为少阴寒利之微。）
少阴病。下利。便脓血者。可刺。（当作灸○少阴病下利。便脓血。最前条已言其治矣。兹又重出其治而云刺
者。当是可灸之误。盖少阴不下利而便脓血。此是阳经传来之热。壅遏于少阴之经。故宜刺以通泄之。今少阴病既
下利矣。复见脓血。曾用桃花汤以温涩之。倘温涩不止。继之以灸。此为辅治之法。方氏条辩既认以为里寒滑脱证。
复注云。刺者。所以通其壅瘀也。借问经中壅瘀。寒邪热邪。知刺法之不可。末又云。可者仅可之词。措词牵强。
大谬之极。○愚按此条论。仲景不言当刺何穴。补亡论常器之云。可刺幽门交信。郭白云云。可灸。考幽门二穴。
在腹部第二行挟巨阙两旁各五分。冲脉足少阴之会。治泄利脓血。可灸五壮。交信二穴在足少阴肾经。内踝上二寸。
少阴前。太阴后廉前筋骨间。治泄利赤白。女子漏血不止。可灸三壮。）
\r幽门交信穴图\pt158a3.bmp\r
少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。此条乃少阴中寒。胃中虚冷。大宜温补之证。少阴
之脉。其直者。上膈。循喉咙。其支者。注胸中。少阴之寒邪甚。则胃中阳气受伤。因作吐利。四肢者禀受于胃。
胃中阳气伤。则手足之气不接续。故厥逆而冷也。经中之寒邪。与阳气相争。阳将耗散。故烦躁欲死。烦出胸中。
此以吐利而因致躁。非吐利躁烦四逆之比。宜吴茱萸汤。以温中补虚散寒。○或问吐利。手足逆冷。烦躁欲死。焉
知非热厥霍乱之证。余答云。热厥霍乱。若吐利。则邪气得泄。手足必温。遂不烦躁欲死矣。今者既吐且利。手足
又冷。烦躁欲死。此烦躁必不如霍乱之甚。其欲死者。必精采不与人相当。而气脱欲死。不若热证之扬手掷足。而
口中大呼欲死。且有少阴病脉微细但欲寐以为证。则知其为虚寒必矣。
赤石脂（一斤，其中一半整块使用，另一半研成细末） 干姜（一两） 粳米（一升）
以上三味药。用水七升。煮粳米至熟烂。滤去药渣。温服七合。服药时加入赤石脂细末一方寸匕。每日服用三次。如果一次服药后病愈，剩余的药不要服用。
成无己注解说：湿性药物可以治疗滑脱不禁之证。赤石脂的涩味，用来固摄肠胃。辛味药物可以发散邪气。干姜的辛味，用来发散体内的寒邪。粳米的甘味，用来补益正气。《内台方议》评论说：阳病出现下利并伴有脓血，属于协热利。应归属于白头翁汤证。少阴病出现下利并伴有脓血，属于下焦约束无力且体内有寒邪。所以用赤石脂作为君药来固摄肠胃。涩味可以治疗滑脱不禁。干姜作为臣药，散寒温阳。这是利用其辛味来发散邪气。粳米作为佐使药，用来补益正气并安和中焦。这是利用其甘味来缓急止痛。
有人问：桃花汤并非专门入少阴经的药物，为什么能治疗少阴病的下利？我回答说：邪气侵犯少阴，寒邪停留在肠胃。张仲景使用桃花汤来治疗寒性下利，也就像治疗少阴病自利清水、颜色纯青、心下必定疼痛、口干燥的情况一样，适宜使用大承气汤。该方剂虽然未直接针对少阴经，但只是通过攻下肠胃中的实热，从而使经络中的热邪自然平息。道理是相同的。
少阴病。发病二三天。到四五天。出现腹痛。小便不利。下利不止。大便带脓血的。用桃花汤主治。（这一条关于少阴病的描述，下利更加严重并伴有腹痛，说明其中的寒邪比之前更重了。少阴经脉行于腹部。现在病症从二三天发展到四五天，寒邪深入体内，所以出现腹痛。小便不利，是因为下焦被寒邪阻滞，阑门受损，水液并入大肠，于是导致下利不止。甚至津液滑脱而出，形成脓血。成无己注解说：肠胃虚弱，下焦不固。给予桃花汤，以温暖胃腑，固摄肠道，散除寒气。○有人问：对于下利脓血，如果不询问疾病是从哪一天开始的，再加上腹痛、小便不利，怎么知道不是协热证呢？我回答说：少阴里寒导致的便脓血，所排出的物质，颜色必然暗滞而不鲜艳。这是因为肾脏受寒湿邪气侵袭，水谷的津液，被其凝滞涩结，酝酿在肠胃之中，从而形成脓血。不像火性急速而颜色鲜明。因为水邪潜伏已久，所以颜色暗黑，气味不臭。病人必然脉象微细，精神安静，腹部疼痛不剧烈，喜欢温暖，想要用手按压腹部，腹痛就会停止。这才是少阴寒性下利的轻微表现。）
少阴病。下利。大便带脓血的。可以针刺。（应当是艾灸○少阴病下利，大便带脓血，在前一条已经说明了治疗方法。这里再次重复提出治疗方法并说“刺”，应当是“灸”字的误写。盖因少阴病不下利而仅便脓血，这是阳经传来的热邪，壅遏在少阴经脉中，所以适宜针刺以通泄热邪。现在少阴病既然已经下利，又见到脓血，曾用桃花汤进行温涩治疗。如果温涩无效，继之以艾灸，这是辅助治疗的方法。方有执的《伤寒论条辨》既然认定这是里寒滑脱证，又注释说：“刺”，是用来疏通壅滞瘀血。试问经络中的壅滞瘀血，是寒邪还是热邪？可知针刺法并不适用。最后又说“可”字仅仅是“仅可”的意思，措辞牵强，大错特错。○我认为这一条论述，张仲景没有说明应当针刺哪个穴位。《补亡论》常器之说：可以针刺幽门穴、交信穴。郭白云说：可以艾灸。考察幽门两穴，位于腹部第二行，挟巨阙穴两旁各五分处，是冲脉与足少阴经的交会穴，治疗泄利脓血，可艾灸五壮。交信两穴在足少阴肾经，内踝上二寸，少阴经之前，太阴经之后，廉骨前筋骨之间，治疗泄利赤白，女子漏血不止，可艾灸三壮。）
少阴病。呕吐下利。手足冰冷。烦躁得快要死去的。用吴茱萸汤主治。这一条乃是少阴中寒，胃中虚冷，非常适宜温补的证候。少阴经脉，直行者，上行穿过膈肌，沿喉咙。分支者，注入胸中。少阴的寒邪严重，则胃中阳气受伤，因此产生呕吐下利。四肢的气血禀受于胃。胃中阳气受伤，则手足之气不能接续，所以发生厥逆而寒冷。经络中的寒邪，与阳气相争，阳气将要耗散，所以烦躁欲死。烦出自胸中，这是由于呕吐下利而导致躁动，不同于吐利、躁烦、四肢逆冷的情况。适宜用吴茱萸汤，以温中补虚散寒。○有人问：呕吐下利，手足逆冷，烦躁欲死，怎么知道不是热厥霍乱的证候呢？我回答说：热厥霍乱，如果出现吐利，则邪气得以宣泄，手足必然温暖，随即不再烦躁欲死了。现在既呕吐又下利，手足又冷，这种烦躁一定不如霍乱那样严重。那种“欲死”的状态，一定是神采不与外界相应，而气脱欲死，不像热证那样扬手掷足，口中大声呼救欲死。并且还有少阴病脉微细、只想睡觉作为佐证，那么就知道这必然是虚寒证了。
Chishizhi (Lithogypsi Folium, one jin; half used whole, half sifted into powder) Ganjiang (Zingiberis Rhizoma, one liang) Jingmi (Oryzae Fructus Rotundatus, one sheng)
The above three ingredients. Boil with seven sheng of water. Cook the rice until soft. Remove the dregs. Take seven he of the decoction warm. Add one fangcunbi of Chishizhi powder to the dose. Administer three times daily. If cured after one dose, do not take the remaining medicine.
Cheng Wuji's commentary states: Moistening agents can treat sliding and incontinence. The astringent nature of Chishizhi secures the intestines and stomach. Pungent agents disperse pathogenic factors. The pungency of Ganjiang disperses interior cold. The sweetness of Jingmi tonifies healthy qi. *Neitai Fangyi* comments: In Yang disease, diarrhea with pus and blood indicates heat-coupling (Xie Re). It belongs to the syndrome treated by Baitouweng Tang. In Shaoyin disease, diarrhea with pus and blood indicates failure of the lower jiao to constrain and interior cold. Therefore, Chishizhi is used as the sovereign drug to secure the intestines and stomach. Astringency treats sliding and incontinence. Ganjiang serves as the minister drug, dispelling cold and warming yang. This utilizes its pungency to disperse pathogenic factors. Jingmi serves as the assistant and envoy drugs, tonifying healthy qi and harmonizing the middle jiao. This utilizes its sweetness to relieve urgency and pain.
A question arises: Taohua Tang is not a formula specifically entering the Shaoyin channel; why does it treat diarrhea in Shaoyin disease? I answer: Pathogens invade Shaoyin, and cold remains in the intestines and stomach. Zhang Zhongjing uses Taohua Tang to treat cold-type diarrhea, just as he treats Shaoyin disease with spontaneous diarrhea of clear water, pure green color, severe pain in the epigastrium, and dry mouth/throat, for which Dachengqi Tang is indicated. Although that formula does not directly target the Shaoyin channel, it merely purges excess heat from the intestines and stomach, thereby naturally resolving the heat within the channels. The principle is the same.
Shaoyin disease. After two or three days, progressing to four or five days, abdominal pain occurs. Urination is difficult. Diarrhea persists without cessation. Stool contains pus and blood. Taohua Tang is the primary treatment. (In this clause regarding Shaoyin disease, the diarrhea is more severe accompanied by abdominal pain, indicating that the interior cold is heavier than before. The Shaoyin meridian runs along the abdomen. Now, since the illness has progressed from two or three days to four or five days, the cold pathogen has entered deeply into the interior, causing abdominal pain. Difficulty in urination occurs because the lower jiao is obstructed by cold pathogens, damaging the Lanmen [gate between small and large intestine], causing fluids to merge into the large intestine, leading to persistent diarrhea. Eventually, body fluids slide out uncontrollably, forming pus and blood. Cheng Wuji notes: Intestines and stomach are weak, and the lower jiao is insecure. Provide Taohua Tang to warm the stomach, secure the intestines, and dissipate cold qi. ○ A question arises: Regarding diarrhea with pus and blood, if one does not ask when the disease started, and given abdominal pain and difficulty in urination, how can one know it is not a heat-coupling syndrome? I answer: In Shaoyin interior cold causing pus and blood in stool, the discharged material must be dark and not bright. This is because the Kidney receives cold-damp pathogens, condensing the fluids of food and drink, which ferment in the intestines and stomach to form pus and blood. Unlike fire pathology which is rapid and bright in color, water pathogens have been latent for a long time, hence the dark black color and lack of foul odor. The patient will definitely present with a faint and fine pulse, quiet spirit, mild abdominal pain, preference for warmth, and desire for abdominal pressure, which stops the pain. This represents the mild presentation of Shaoyin cold diarrhea.)
Shaoyin disease. Diarrhea. Stool contains pus and blood. Acupuncture may be applied. (Should be moxibustion ○ Shaoyin disease with diarrhea and pus/blood was already addressed in the previous clause. Repeating the treatment here as "acupuncture" is likely an error for "moxibustion". Generally, if Shaoyin disease presents with pus/blood but no diarrhea, it is heat transmitted from Yang channels obstructing the Shaoyin channel, suitable for acupuncture to vent and drain. However, now that Shaoyin disease involves diarrhea and pus/blood, having already used Taohua Tang for warming and astringing, if ineffective, moxibustion follows as an auxiliary treatment. Fang Youzhi's *Shanghan Lun Tiaobian*, recognizing this as interior cold and sliding incontinence, yet annotating "acupuncture" as a method to unblock stagnation and stasis, asks whether the stagnation is due to cold or heat, concluding acupuncture is inappropriate. He further claims "ke" (may/can) implies "only barely," a forced phrasing, extremely erroneous. ○ I observe that in this clause, Zhang Zhongjing does not specify which acupoints to needle. Chang Qizhi in *Buwang Lun* states: One may needle Yongmen and Jiaoxin. Guo Baiyun states: One may apply moxibustion. Examining Yongmen points: located on the second row of the abdomen, five fen lateral to Juque, intersections of the Chong Mai and Foot-Shaoyin meridians, treating diarrhea with pus/blood; moxa five zhuang. Jiaoxin points: on the Foot-Shaoyin Kidney Meridian, two cun above the medial malleolus, anterior to Shaoyin, posterior to Taiyin, between the tibia and bone; treating dysentery with red/white discharge and metrorrhagia in women; moxa three zhuang.)
\rImage of Yongmen and Jiaoxin Acupoints\pt158a3.bmp\r
Shaoyin disease. Vomiting and diarrhea. Cold extremities. Restlessness bordering on death. Wuzhuyu Tang is the primary treatment. This clause describes Shaoyin cold invasion, deficiency-cold in the stomach, a syndrome highly suitable for warming and tonification. The Shaoyin meridian, the straight branch, ascends through the diaphragm and follows the throat. The branch enters the chest. Severe Shaoyin cold damages stomach yang, causing vomiting and diarrhea. Limbs derive their qi from the stomach. Damage to stomach yang causes discontinuity of qi in hands and feet, resulting in reversal cold (Jue Ni). Cold pathogens in the channels contend with healthy qi, which is about to dissipate, causing restlessness bordering on death. Restlessness originates from the chest; this is agitation caused by vomiting and diarrhea, distinct from the combination of vomiting, diarrhea, restlessness, and cold extremities. Wuzhuyu Tang is indicated to warm the middle, tonify deficiency, and dissipate cold. ○ A question arises: Vomiting and diarrhea, cold extremities, restlessness bordering on death; how can one know it is not Heat-Jue or Huoluan? I answer: In Heat-Jue or Huoluan, if vomiting and diarrhea occur, pathogens are expelled, extremities become warm, and restlessness ceases. Now, with both vomiting and diarrhea, and cold extremities, the restlessness is certainly less severe than in Huoluan. The "bordering on death" state implies spirit disconnects from the exterior and qi is about to collapse, unlike heat syndromes where patients throw limbs about and shout loudly. Furthermore, the presence of Shaoyin disease indicators—faint/fine pulse and desire to sleep—confirms this is undoubtedly a deficiency-cold syndrome.